Individual
JAMIE RENE FAIRRES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3202 W BLAND ST, ROSWELL, NM 88203-1279
(575) 317-0941
Mailing address
3202 W BLAND ST, ROSWELL, NM 88203-1279
(575) 317-0941
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/01/2018
Last updated
02/01/2018
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